Louisiana's New Governor Wants Medicaid Expansion in Place by July 1

Democrat John Bel Edwards becomes Louisiana’s new governor today, and he vowed this weekend to move quickly on Medicaid expansion, with new enrollees having their cards in nand by July 1.

Edwards has appointed Rebekah Gee, MD, MPH, as his secretary of the Department of Health and Hospitals. Gee is on the faculty of LSU and serves as the state’s Medicaid medical director.

One of her first declarations was that the department would need to hire 248 employees to recover from the cuts of outgoing Governor Bobby Jindal’s tenure and to have enough staff to enroll the estimated 300,000 residents who are expected to take advantage of Medicaid expansion in one of the poorest states in the country.

“This governor,” Gee said of Jindal, “has downsized considerably the human resources that we have to tackle big problems.” Federal dollars will cover 75% of the cost of the new staff.

The incoming governor has vowed to set in motion the process of Medicaid expansion in motion no later than tomorrow. The legislature previously took some steps to pave the way for expansion despite Jindal’s refusal to pursue expansion, but there is some question whether legal barriers remain in Edwards’ path. He has vowed to do whatever it takes.

“Within 24 hours of being sworn in, we will issue the executive order,” he told The Advocate in an interview this weekend. “That will start the process of expansion, which we believe we can do by July 1, 2016.”

Critics of Jindal’s position toward Medicaid expansion note that Louisiana is not only a poor state, but it also is at or near the top is many indicators of poor health. It is famously home to “cancer alley,” a stretch between Baton Rouge and New Orleans that is home to the petrochemical industry. The state also has high rates of smoking, obesity, and diabetes. Jindal's position was especially seen as cynical given that he once proposed a very similar approach to Medicaid before the introduction of the Affordable Care Act. But once the ACA became law, he reversed course and denounced it as "Obamacare." In fact, Jindal became one of the law's most vocal critics.

When the ACA passed, it was not assumed that states would be able to opt out of expansion. Jindal did so, even though the state's new medical school was under construction and extra Medicaid payments were assumed. Observers who spoke with The American Journal of Managed Care in 2013, as Louisiana was going through the marriages of its public and private hospitals, said many planned to "wait out" Jindal and assumed expansion would come with the next governor.

A quarter of Louisiana's residents are already enrolled in Medicaid, and US census figures suggest that up to 11% more of the population could enroll under expansion.